SMOKING INTERVENTIONS FOR LOW INCOME PREGNANT WOMEN

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This five year Demonstration and Education project, the Provider-Delivered Smoking Intervention Project Plus (PDSIP+), will implement and evaluate the effect of a multicomponent intervention on the smoking cessation and maintenance rates of culturally-diverse, socioeconomically-disadvantaged, pregnant women (Hispanic, Black American and Caucasian) enrolled in the Women, Infants and Children (WIC) supplemental nutrition program. Three provider channels will deliver the interventions: l) WlC nutritionists during pregnancy and postpartum; 2) obstetricians (OB) and clinic staffs during pregnancy; and 3) pediatricians (PED) and clinic staffs during postpartum. A time-efficient yet intensive patient-centered intervention protocol will be used. This intervention has been previously demonstrated to be efficacious when used by general internists and family practitioners with a general population of smokers, and to be usable by WIC nutritionists. Three paired Massachusetts WIC sites and their related OB and PED clinics within Community Health Centers will be randomized to special intervention (SI) or usual care (UC). SI sites will receive training in the patient-Centered intervention, and establish an office practice management system to support intervention, which includes a system for linking the three channels of intervention delivery. UC sites will receive no intervention. In each of the three SI sites, an organizational assessment will be completed, a Health Center Operations Board will be established to tailor implementation of the intervention in each site. Then each of the SI provider channels (WlC, OB and PED) will receive intervention training consisting of a structured group program with brief individual followup sessions. Written questionnaires will be done at baseline of SI and UC providers at post-training of SI providers, and at one year followup of both Sl and LC providers. Provider adherence to the intervention will be measured by patient exit interviews (WIC providers in SI and UC), chart audit (SI only) and retrospective patient report in patient interviews. Eligible pregnant women will have a baseline interview during their WlC enrollment visit. A brief assessment involving smoking status (with saliva cotinine validation of reported cessation), stage of change and report of provider intervention behavior will occur at ninth month of pregnancy, 3- and 9-months postpartum. A more comprehensive assessment will be conducted at l- and 6-months postpartum. Maintenance of cessation and overall non-smoking rates will be determined at each assessment point. The results of this study will demonstrate the effectiveness of a multicomponent program of linked providers, which is feasible and generalizable to other behaviors and other settings serving low-income, multicultural pregnant women.